Metaldehyde, a cyclic tetramer of acetaldehyde, is a widely used molluscicide. Although cases wit... more Metaldehyde, a cyclic tetramer of acetaldehyde, is a widely used molluscicide. Although cases with acute metaldehyde poisoning have been reported, the occurrence of severe poisoning is uncommon. To provide more information on human metaldehyde poisoning, we reviewed 15 cases of metaldehyde exposure reported to the Taiwan National Poison Control Center at the Taipei Veterans General Hospital between 1991 and 2002. While 7 patients were asymptomatic, the other 8 patients, including 4 who coingested alcohol or other poisons, exhibited toxic manifestations of abdominal pain, dizziness, nausea, irritation of oral mucosa, and seizures after oral exposure. One patient died after ingesting 12 g (or 258.6 mg/kg) of metaldehyde. Although the toxicity from metaldehyde is largely mild, the clinical course of metaldehyde poisoning may be rapidly deteriorating and fatal on rare occasions. Physicians should therefore be cautious in managing patients with metaldehyde poisoning, and vigorous support...
Diabetes is a chronic disease requiring frequent monitoring that may be accompanied by considerab... more Diabetes is a chronic disease requiring frequent monitoring that may be accompanied by considerable quality of life (QOL) burden. Low- and middle-income countries such as Swaziland are facing a double disease burden exacerbated by the high prevalence of infectious diseases. This study aimed to understand the QOL and its correlates in diabetic outpatients in Swaziland. Participants were consecutively recruited during their routine visits to a referral hospital in Swaziland. Face-to-face interviews were conducted with outpatients using the Diabetes-39 questionnaire to measure their QOL. Raw scores were transformed to a standard domain-specific score using linear transformation with scores ranging from 0 (lowest impact) to 100 (highest impact). Among the 340 participants in this cross-sectional study anxiety and worry was the most affected QOL domain. In multiple linear regression analyses, the presence of complications and/or comorbidities, low income, limited education and being on i...
Severe electrolyte disturbances caused by fish poisoning are rarely reported in the literature. W... more Severe electrolyte disturbances caused by fish poisoning are rarely reported in the literature. We present an unusual outbreak of palytoxin poisoning associated with the consumption of Goldspot herring (Herklotsichthys quadrimaculatus). Four family members became ill after eating 2 species of marine fish. The presenting symptoms and signs included bitter taste, oral numbness, nausea, vomiting, abdominal pain, and hypertension, which were followed by myalgia, limb numbness, sensorimotor polyneuropathy, and abnormal cold and warm sensations. The index case manifested hyperkalemia, hyperphosphatemia, and acute kidney injury, and developed severe cardiac dysrhythmias. He died 21 hours postingestion. Palytoxin and related compounds were identified by liquid chromatography tandem mass spectrometry in one of the leftover fish. Palytoxin poisoning is rarely reported and is difficult to diagnose in the absence of laboratory confirmation. Palytoxin poisoning should be considered in patients w...
Acute ingestion of copper sulfate has been reported to cause gastrointestinal injury, hemolysis, ... more Acute ingestion of copper sulfate has been reported to cause gastrointestinal injury, hemolysis, methemoglobinemia, hepatorenal failure, shock; or even death. The toxicity of organocopper compounds, however, remains largely unknown. A 40-y-old man attempted suicide by ingesting some 50 ml of Sesamine fungicide. He immediately developed headache, vomiting and abdominal pain, followed by progressive dyspnea, cyanosis, dark urine and diarrhea. Severe methemoglobinemia and hemolysis were documented, and treatment with ascorbic acid and hydration was commenced. He was referred to our service 3 d later for methylene blue treatment. Despite the above treatment, his symptomatology persisted and it was not until 5 d post-ingestion that the implicated fungicide was identified as copper-8-hydroxyquinolate. BAL therapy and plasma exchange were instituted, which decreased his plasma hemoglobin from 1,300 mg/dL to 29.1 mg/dL, and lowered his methemoglobin level from 20.9% to 1.1%. His serum and u...
The PCC-Taiwan was founded in July 1985 under the auspices of the Department of Health, Executive... more The PCC-Taiwan was founded in July 1985 under the auspices of the Department of Health, Executive Yuan, and the Veterans General Hospital-Taipei, Republic of China. It has served a population of 21 million inhabitants on a 24-hours basis. It has also served as a referral center for treating poisoning cases nationwide, a training center for physicians and consultants, and a center for Analytical Toxicology. The average annual volume of telephone inquires to PCC is more than four thousand in recent few years and continue to increase annually. The present and future prospective of the PCC-Taiwan which have to be accomplished are: 1. to propagate public education of poisoning prevention and increase the utility of PCC before events of intoxication, 2. to establish, computerize and improve the database and network of domestic poisonous products or natural toxins, including herbs, 3. to establish an nationwide referral network for severely poisoned patients or cluster poisoning events, 4. to build up a global collaborative work with other poison centers.
Comfrey (Symphytum officinale) leaves resemble those of foxglove (Digitalis purpurea) when the pl... more Comfrey (Symphytum officinale) leaves resemble those of foxglove (Digitalis purpurea) when the plant is not in bloom and, therefore, cardiac glycoside poisoning may occur when people confuse foxglove with comfrey. We report an outbreak of foxglove leaf poisoning following the use of alleged "comfrey" herbal tea. Nine patients were involved and initially presented with nausea, vomiting, diarrhea and dizziness. Significant cardiotoxicity developed later among the 3 patients who also had mild hyperkalemia. Peak serum digoxin concentration measured by immunoassay was elevated in all patients and ranged from 4.4 ng/mL to 139.5 ng/mL. Patients with severe cardiotoxicity were treated with temporary cardiac pacing. Moreover, 40-80 mg of digoxin-specific antibody therapy was given without any effect. All patients recovered uneventfully. Our report highlights the potential risk of misidentification of herbs; in this case, D. purpurea was mistaken for S. officinale. Physicians should be aware that cardiac glycoside poisoning could arise from such misidentification. Public education about the toxicity of D. purpurea poisoning may reduce the risk of misidentification and subsequent poisoning.
Background: The effects of various cardiovascular diseases on the risk of venous thromboembolism ... more Background: The effects of various cardiovascular diseases on the risk of venous thromboembolism (VTE) are not well defined. To gather more information, we performed a hospital-based case-control study to evaluate the effects of major cardiovascular diseases on the risk of VTE. Methods: We identified all incident cases of VTE needing hospitalization and anticoagulant therapy between January 1990 and December 2002 in a large tertiary hospital. Each case was matched with up to 4 controls, randomly selected from inpatients who were not hospitalized due to any of the exposures, on age, sex, calendar time and veteran/ nonveteran status. Results: This study comprised 173 cases of VTE and 546 matched controls. The adjusted odds ratio (OR) of VTE was significant among patients with peripheral atherosclerotic diseases (OR 7.1, 95% confidence interval [CI] 1.4-34.4), and nondebilitating cerebrovascular diseases (OR 2.5, 95% CI 1.4-4.7). Other independent risk factors for VTE included a body mass index ≥ 25.0 kg/m 2 , current estrogen use, a history of hyperlipidemia and varicose veins. Conclusion: Peripheral atherosclerotic disease and nondebilitating cerebrovascular disease are important risk factors for VTE. Patients with these diseases should therefore be frequently evaluated for the possible coexistence of VTE and, if appropriate, should be given prophylaxis. Failure to take into account the potential confounding effects of these diseases may also result in an erroneous estimate of the effect of drug exposures on the risk of idiopathic VTE. [J Chin Med Assoc 2007;70(3):103-109] *Adjusted for matching factors (age, sex, index date, veteran/nonveteran status) and baseline characteristics (body mass index, estrogen use, hyperlipidemia, varicose veins). OR = odds ratio; CI = confidence interval.
Cardiotoxicity in acute aconitine intoxication is well known; however, elevation of troponin I le... more Cardiotoxicity in acute aconitine intoxication is well known; however, elevation of troponin I level and abnormal scintigraphy findings had not previously been reported. A 60-year-old man developed chest tightness, syncope and convulsion after ingesting processed Aconitum carmichaeli (Chuanwu) extract for treatment of headache. Electrocardiogram showed first degree atrioventricular (AV) block. Troponin I level was elevated at 14.8 ng/mL 13 hours post-ingestion. Creatine kinase was also increased to 414 U/L. However, echocardiography did not show any abnormal cardiac wall motion. Tc-99m-PYP scintigraphy revealed diffusely increased uptake in the myocardium, suggesting the presence of myocardial necrosis or myocarditis. Aconitine poisoning can mimic acute myocardial infarction with chest tightness and elevated cardiac enzymes. Increased cardiac markers and myocardial insult seen in this patient were likely to be related to the toxicity of aconitine. Care should be taken in making the diagnosis in such instances. Management is primarily supportive.
Intoxication by orphenadrine is uncommon. The clinical features consist of both central and perip... more Intoxication by orphenadrine is uncommon. The clinical features consist of both central and peripheral anticholinergic effects. Ingestion of 2 to 3 g orphenadrine in an adult has been associated with fatality. A 46-year-old female was brought to our emergency department 1.5 hours after ingesting 40 tablets of 100 mg orphenadrine. She became stuporous 3 hours post-ingestion and developed generalized convulsions 1 hour later. Fifty-five hours post-ingestion, she had recovered and was found to have anterior shoulder dislocation. In addition, severe rhabdomyolysis and persistent nausea were observed. All of the above-noted toxic effects resolved with conservative treatment. Although orphenadrine intoxication can cause convulsions and hemodynamic instability, there is no available antidote and treatment remains supportive.
Alachlor and butachlor are commonly used herbicides. However, data on acute human poisonings are ... more Alachlor and butachlor are commonly used herbicides. However, data on acute human poisonings are scarce. We retrospectively analyzed the data of human alachlor/butachlor poisoning in Taiwan. The study period ran from October 1986 through February 2007. Sixty-three alachlor and 70 butachlor poisoning cases were reported to the Taiwan National Poison Center during the study period. Clinical data were reviewed and analyzed. Most patients intentionally ingested the herbicides. The toxicities of alachlor and butachlor were largely similar. Twenty-eight out of 102 patients with oral exposure were asymptomatic, while the others developed vomiting, central nervous system depression, and other outcomes. Among patients using other exposure pathways, gastrointestinal effects were the main manifestation. Three patients died after manifesting profound hypotension and/or coma following alachlor ingestion. Alachlor and butachlor poisonings are usually of low toxicity. However, severe neurological and cardiovascular outcomes may develop rarely, especially following oral ingestion. Medical management of such poisonings is primarily supportive.
The Taiwan National Poison Center has received more than 30,000 telephone calls since its establi... more The Taiwan National Poison Center has received more than 30,000 telephone calls since its establishment in July 1985. To obtain more information about poisoning exposures in Taiwan, a retrospective analysis was conducted of all telephone calls to the center concerning human poisoning exposures July 1985 through December 1993. The following data were tabulated: age, sex, intent of exposure, route of exposure, substances ingested and clinical severity. During the eight years (1985-1993), 23,436 telephone calls concerning human poisoning exposure were recorded. Adults accounted for most cases (75.2%) and exposures involving males (54.2%) were somewhat more prevalent than female poisoning exposures (44.7%). Intentional poisonings (54.6%) were more common than unintentional poisonings (40.1%), with an inverse relationship in pediatric poisoning exposures. After amphetamines, the most frequently ingested poisons were pesticides, benzodiazepines, and cleaning products. Fatalities occurred most frequently following ingestion of pesticides. The mortality rate was 5.7% for all exposures. Human poisoning is a serious problem in Taiwan. The reduction of suicide attempts is a major objective. Childhood poisonings are underreported and of high mortality.
Insufficient hospital stock of a variety of poisoning antidotes is a worldwide problem. In an att... more Insufficient hospital stock of a variety of poisoning antidotes is a worldwide problem. In an attempt to establish an antidote storage and distribution system for the response of the various poisoning accidents, we conducted a nationwide survey to characterize the current availability of selected antidotes and their anticipated need in Taiwan. A questionnaire was mailed to 834 hospitals to gather information on the availability, anticipated need, and preferred purchase policy of 20 selected antidotes. A survey on the availability of cyanide antidote in 523 cyanide-handling facilities and their neighboring hospitals was also conducted. Hospitals of different size and service levels had a statistically significant difference in response rates. Except for pyridoxine, the availability and anticipated need for antidotes also varied significantly among different hospital groups. We found that physostigmine, cyanide antidote kit, BAL, EDTA, methylene blue, Vipera Russell formosensis antivenin, and botulism antitoxin were not available in most (>90%) hospitals. Interestingly, these antidotes are also among the most needed antidotes. Most hospitals preferred a government-ordered purchase of antidotes. In the survey of cyanide-processing facilities, a response rate of 24.1% was obtained and only 9.3% of these 107 facilities that both replied to the questionnaire and continued handling cyanide products had stocked cyanide antidote. It is noteworthy that cyanide antidote was also frequently lacking in the neighboring hospitals. The appropriate storage of antidotes in hospitals or workplaces in rural areas is instrumental in the timely treatment of certain poisonings, while nationwide unavailability is the critical problem. Raising awareness of the importance of antidotes by education, regular review of antidote storage, distribution plans, and appropriate legislation might provide solutions.
Metaldehyde, a cyclic tetramer of acetaldehyde, is a widely used molluscicide. Although cases wit... more Metaldehyde, a cyclic tetramer of acetaldehyde, is a widely used molluscicide. Although cases with acute metaldehyde poisoning have been reported, the occurrence of severe poisoning is uncommon. To provide more information on human metaldehyde poisoning, we reviewed 15 cases of metaldehyde exposure reported to the Taiwan National Poison Control Center at the Taipei Veterans General Hospital between 1991 and 2002. While 7 patients were asymptomatic, the other 8 patients, including 4 who coingested alcohol or other poisons, exhibited toxic manifestations of abdominal pain, dizziness, nausea, irritation of oral mucosa, and seizures after oral exposure. One patient died after ingesting 12 g (or 258.6 mg/kg) of metaldehyde. Although the toxicity from metaldehyde is largely mild, the clinical course of metaldehyde poisoning may be rapidly deteriorating and fatal on rare occasions. Physicians should therefore be cautious in managing patients with metaldehyde poisoning, and vigorous support...
Diabetes is a chronic disease requiring frequent monitoring that may be accompanied by considerab... more Diabetes is a chronic disease requiring frequent monitoring that may be accompanied by considerable quality of life (QOL) burden. Low- and middle-income countries such as Swaziland are facing a double disease burden exacerbated by the high prevalence of infectious diseases. This study aimed to understand the QOL and its correlates in diabetic outpatients in Swaziland. Participants were consecutively recruited during their routine visits to a referral hospital in Swaziland. Face-to-face interviews were conducted with outpatients using the Diabetes-39 questionnaire to measure their QOL. Raw scores were transformed to a standard domain-specific score using linear transformation with scores ranging from 0 (lowest impact) to 100 (highest impact). Among the 340 participants in this cross-sectional study anxiety and worry was the most affected QOL domain. In multiple linear regression analyses, the presence of complications and/or comorbidities, low income, limited education and being on i...
Severe electrolyte disturbances caused by fish poisoning are rarely reported in the literature. W... more Severe electrolyte disturbances caused by fish poisoning are rarely reported in the literature. We present an unusual outbreak of palytoxin poisoning associated with the consumption of Goldspot herring (Herklotsichthys quadrimaculatus). Four family members became ill after eating 2 species of marine fish. The presenting symptoms and signs included bitter taste, oral numbness, nausea, vomiting, abdominal pain, and hypertension, which were followed by myalgia, limb numbness, sensorimotor polyneuropathy, and abnormal cold and warm sensations. The index case manifested hyperkalemia, hyperphosphatemia, and acute kidney injury, and developed severe cardiac dysrhythmias. He died 21 hours postingestion. Palytoxin and related compounds were identified by liquid chromatography tandem mass spectrometry in one of the leftover fish. Palytoxin poisoning is rarely reported and is difficult to diagnose in the absence of laboratory confirmation. Palytoxin poisoning should be considered in patients w...
Acute ingestion of copper sulfate has been reported to cause gastrointestinal injury, hemolysis, ... more Acute ingestion of copper sulfate has been reported to cause gastrointestinal injury, hemolysis, methemoglobinemia, hepatorenal failure, shock; or even death. The toxicity of organocopper compounds, however, remains largely unknown. A 40-y-old man attempted suicide by ingesting some 50 ml of Sesamine fungicide. He immediately developed headache, vomiting and abdominal pain, followed by progressive dyspnea, cyanosis, dark urine and diarrhea. Severe methemoglobinemia and hemolysis were documented, and treatment with ascorbic acid and hydration was commenced. He was referred to our service 3 d later for methylene blue treatment. Despite the above treatment, his symptomatology persisted and it was not until 5 d post-ingestion that the implicated fungicide was identified as copper-8-hydroxyquinolate. BAL therapy and plasma exchange were instituted, which decreased his plasma hemoglobin from 1,300 mg/dL to 29.1 mg/dL, and lowered his methemoglobin level from 20.9% to 1.1%. His serum and u...
The PCC-Taiwan was founded in July 1985 under the auspices of the Department of Health, Executive... more The PCC-Taiwan was founded in July 1985 under the auspices of the Department of Health, Executive Yuan, and the Veterans General Hospital-Taipei, Republic of China. It has served a population of 21 million inhabitants on a 24-hours basis. It has also served as a referral center for treating poisoning cases nationwide, a training center for physicians and consultants, and a center for Analytical Toxicology. The average annual volume of telephone inquires to PCC is more than four thousand in recent few years and continue to increase annually. The present and future prospective of the PCC-Taiwan which have to be accomplished are: 1. to propagate public education of poisoning prevention and increase the utility of PCC before events of intoxication, 2. to establish, computerize and improve the database and network of domestic poisonous products or natural toxins, including herbs, 3. to establish an nationwide referral network for severely poisoned patients or cluster poisoning events, 4. to build up a global collaborative work with other poison centers.
Comfrey (Symphytum officinale) leaves resemble those of foxglove (Digitalis purpurea) when the pl... more Comfrey (Symphytum officinale) leaves resemble those of foxglove (Digitalis purpurea) when the plant is not in bloom and, therefore, cardiac glycoside poisoning may occur when people confuse foxglove with comfrey. We report an outbreak of foxglove leaf poisoning following the use of alleged "comfrey" herbal tea. Nine patients were involved and initially presented with nausea, vomiting, diarrhea and dizziness. Significant cardiotoxicity developed later among the 3 patients who also had mild hyperkalemia. Peak serum digoxin concentration measured by immunoassay was elevated in all patients and ranged from 4.4 ng/mL to 139.5 ng/mL. Patients with severe cardiotoxicity were treated with temporary cardiac pacing. Moreover, 40-80 mg of digoxin-specific antibody therapy was given without any effect. All patients recovered uneventfully. Our report highlights the potential risk of misidentification of herbs; in this case, D. purpurea was mistaken for S. officinale. Physicians should be aware that cardiac glycoside poisoning could arise from such misidentification. Public education about the toxicity of D. purpurea poisoning may reduce the risk of misidentification and subsequent poisoning.
Background: The effects of various cardiovascular diseases on the risk of venous thromboembolism ... more Background: The effects of various cardiovascular diseases on the risk of venous thromboembolism (VTE) are not well defined. To gather more information, we performed a hospital-based case-control study to evaluate the effects of major cardiovascular diseases on the risk of VTE. Methods: We identified all incident cases of VTE needing hospitalization and anticoagulant therapy between January 1990 and December 2002 in a large tertiary hospital. Each case was matched with up to 4 controls, randomly selected from inpatients who were not hospitalized due to any of the exposures, on age, sex, calendar time and veteran/ nonveteran status. Results: This study comprised 173 cases of VTE and 546 matched controls. The adjusted odds ratio (OR) of VTE was significant among patients with peripheral atherosclerotic diseases (OR 7.1, 95% confidence interval [CI] 1.4-34.4), and nondebilitating cerebrovascular diseases (OR 2.5, 95% CI 1.4-4.7). Other independent risk factors for VTE included a body mass index ≥ 25.0 kg/m 2 , current estrogen use, a history of hyperlipidemia and varicose veins. Conclusion: Peripheral atherosclerotic disease and nondebilitating cerebrovascular disease are important risk factors for VTE. Patients with these diseases should therefore be frequently evaluated for the possible coexistence of VTE and, if appropriate, should be given prophylaxis. Failure to take into account the potential confounding effects of these diseases may also result in an erroneous estimate of the effect of drug exposures on the risk of idiopathic VTE. [J Chin Med Assoc 2007;70(3):103-109] *Adjusted for matching factors (age, sex, index date, veteran/nonveteran status) and baseline characteristics (body mass index, estrogen use, hyperlipidemia, varicose veins). OR = odds ratio; CI = confidence interval.
Cardiotoxicity in acute aconitine intoxication is well known; however, elevation of troponin I le... more Cardiotoxicity in acute aconitine intoxication is well known; however, elevation of troponin I level and abnormal scintigraphy findings had not previously been reported. A 60-year-old man developed chest tightness, syncope and convulsion after ingesting processed Aconitum carmichaeli (Chuanwu) extract for treatment of headache. Electrocardiogram showed first degree atrioventricular (AV) block. Troponin I level was elevated at 14.8 ng/mL 13 hours post-ingestion. Creatine kinase was also increased to 414 U/L. However, echocardiography did not show any abnormal cardiac wall motion. Tc-99m-PYP scintigraphy revealed diffusely increased uptake in the myocardium, suggesting the presence of myocardial necrosis or myocarditis. Aconitine poisoning can mimic acute myocardial infarction with chest tightness and elevated cardiac enzymes. Increased cardiac markers and myocardial insult seen in this patient were likely to be related to the toxicity of aconitine. Care should be taken in making the diagnosis in such instances. Management is primarily supportive.
Intoxication by orphenadrine is uncommon. The clinical features consist of both central and perip... more Intoxication by orphenadrine is uncommon. The clinical features consist of both central and peripheral anticholinergic effects. Ingestion of 2 to 3 g orphenadrine in an adult has been associated with fatality. A 46-year-old female was brought to our emergency department 1.5 hours after ingesting 40 tablets of 100 mg orphenadrine. She became stuporous 3 hours post-ingestion and developed generalized convulsions 1 hour later. Fifty-five hours post-ingestion, she had recovered and was found to have anterior shoulder dislocation. In addition, severe rhabdomyolysis and persistent nausea were observed. All of the above-noted toxic effects resolved with conservative treatment. Although orphenadrine intoxication can cause convulsions and hemodynamic instability, there is no available antidote and treatment remains supportive.
Alachlor and butachlor are commonly used herbicides. However, data on acute human poisonings are ... more Alachlor and butachlor are commonly used herbicides. However, data on acute human poisonings are scarce. We retrospectively analyzed the data of human alachlor/butachlor poisoning in Taiwan. The study period ran from October 1986 through February 2007. Sixty-three alachlor and 70 butachlor poisoning cases were reported to the Taiwan National Poison Center during the study period. Clinical data were reviewed and analyzed. Most patients intentionally ingested the herbicides. The toxicities of alachlor and butachlor were largely similar. Twenty-eight out of 102 patients with oral exposure were asymptomatic, while the others developed vomiting, central nervous system depression, and other outcomes. Among patients using other exposure pathways, gastrointestinal effects were the main manifestation. Three patients died after manifesting profound hypotension and/or coma following alachlor ingestion. Alachlor and butachlor poisonings are usually of low toxicity. However, severe neurological and cardiovascular outcomes may develop rarely, especially following oral ingestion. Medical management of such poisonings is primarily supportive.
The Taiwan National Poison Center has received more than 30,000 telephone calls since its establi... more The Taiwan National Poison Center has received more than 30,000 telephone calls since its establishment in July 1985. To obtain more information about poisoning exposures in Taiwan, a retrospective analysis was conducted of all telephone calls to the center concerning human poisoning exposures July 1985 through December 1993. The following data were tabulated: age, sex, intent of exposure, route of exposure, substances ingested and clinical severity. During the eight years (1985-1993), 23,436 telephone calls concerning human poisoning exposure were recorded. Adults accounted for most cases (75.2%) and exposures involving males (54.2%) were somewhat more prevalent than female poisoning exposures (44.7%). Intentional poisonings (54.6%) were more common than unintentional poisonings (40.1%), with an inverse relationship in pediatric poisoning exposures. After amphetamines, the most frequently ingested poisons were pesticides, benzodiazepines, and cleaning products. Fatalities occurred most frequently following ingestion of pesticides. The mortality rate was 5.7% for all exposures. Human poisoning is a serious problem in Taiwan. The reduction of suicide attempts is a major objective. Childhood poisonings are underreported and of high mortality.
Insufficient hospital stock of a variety of poisoning antidotes is a worldwide problem. In an att... more Insufficient hospital stock of a variety of poisoning antidotes is a worldwide problem. In an attempt to establish an antidote storage and distribution system for the response of the various poisoning accidents, we conducted a nationwide survey to characterize the current availability of selected antidotes and their anticipated need in Taiwan. A questionnaire was mailed to 834 hospitals to gather information on the availability, anticipated need, and preferred purchase policy of 20 selected antidotes. A survey on the availability of cyanide antidote in 523 cyanide-handling facilities and their neighboring hospitals was also conducted. Hospitals of different size and service levels had a statistically significant difference in response rates. Except for pyridoxine, the availability and anticipated need for antidotes also varied significantly among different hospital groups. We found that physostigmine, cyanide antidote kit, BAL, EDTA, methylene blue, Vipera Russell formosensis antivenin, and botulism antitoxin were not available in most (>90%) hospitals. Interestingly, these antidotes are also among the most needed antidotes. Most hospitals preferred a government-ordered purchase of antidotes. In the survey of cyanide-processing facilities, a response rate of 24.1% was obtained and only 9.3% of these 107 facilities that both replied to the questionnaire and continued handling cyanide products had stocked cyanide antidote. It is noteworthy that cyanide antidote was also frequently lacking in the neighboring hospitals. The appropriate storage of antidotes in hospitals or workplaces in rural areas is instrumental in the timely treatment of certain poisonings, while nationwide unavailability is the critical problem. Raising awareness of the importance of antidotes by education, regular review of antidote storage, distribution plans, and appropriate legislation might provide solutions.
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